The Opinion Pages|OP-ED CONTRIBUTORS​​ By JAMILA MICHENER and JULILLY KOHLER-HAUSMANN JUNE 28, 2017​

The Senate Republicans’ stalled effort to repeal the Affordable Care Act is not the only profound threat to our health care system. If Gov. Scott Walker gets his wish, Wisconsin will be the first state that requires adults without children to undergo drug testing if they want to receive Medicaid. Other states could follow his plan.This would tie lifesaving health care benefits to government procedures that force people to submit to degrading invasions of privacy. Of all the ways to help Americans with drug problems, threatening their Medicaid eligibility is among the worst options.Much attention has rightly focused on the Senate bill to reduce federal Medicaid spending by as much as $772 billion over the next decade, which would result in 20 million fewer enrollees. But budget cuts are not the only way to weaken Medicaid and limit access to health care.Indeed, President Trump’s insistence on giving “our great state governors the resources and flexibility they need with Medicaid” does just that. While flexibility has at times allowed some states to expand services, others like Arizona, Kentucky and Maine are now attempting to impose conditions, such as time limits or work requirements, that would shrink the program. Because these reforms are more palatable than draconian cuts, they can easily slip beneath the radar and quietly imperil Medicaid’s long-term viability.​It may seem like giving states the power to drug test Medicaid recipients is reasonable. Governor Walker’s administration claims that doing so will “help people get healthy so they can get back in the work force.” And drug screening shouldn’t be a problem for people who are abiding by the law, right?Yet the history of public assistance policies shows that measures like Governor Walker’s can catalyze a vicious cycle of stigmatization and program retrenchment. Traditional cash assistance programs lost popularity as they incorporated practices like fingerprinting, surveillance, time limits and work requirements, and as political rhetoric linked the program with racist representations of African-American mothers.In Wisconsin, where 33 percent of Medicaid beneficiaries are black or Hispanic, the spectacle of calling for drug testing marks people who rely on the government as inherently suspect. When this happens, the public becomes less willing to support such programs and people become less willing to use them, even in times of desperate need. All of this makes the program increasingly vulnerable to further cuts and eventual dismemberment. While no state has been allowed to drug test Medicaid beneficiaries, politicians have initiated similar policies with Temporary Assistance to Needy Families. The results are resoundingly clear: Drug testing is costly, invasive and ineffective. In recent years, seven states with drug-testing programs for T.A.N.F. have spent over $1 million, only to find that in six of them, fewer than 1 percent of beneficiaries tested positive, compared with about 10 percent of the general population.There is no reason to believe that Medicaid recipients are more likely to abuse drugs than the general population. And the risks of drug testing in a health care program are unique. People in need of substance abuse treatment may respond to this policy by avoiding Medicaid altogether. This is a dangerous possibility at a time when more Americans are dying of drug overdose than in car accidents.In fact, one of the most effective strategies for mitigating the harms of drug use has been the Medicaid expansion under the Affordable Care Act, which dramatically increased the number of people with health coverage and required that states provide substance abuse treatment.Under Wisconsin’s proposal, people who use drugs will not automatically lose benefits, but they will be forced to undergo screening, testing or treatment, or all three, to maintain eligibility, which risks driving people from the program. Given the current opioid crises, states should not erect any barriers to health care access or treatment.And drug testing doesn’t hurt only people who use drugs. Associating all Medicaid beneficiaries with a scorned social group, drug users, poses a danger to everyone’s health. Such stigmatization can prevent people who are eligible for assistance from using it and inhibit those in need from seeking medical treatment.Drug testing also jeopardizes our democracy. For many of the more than 70 million Americans who rely on Medicaid, state-run programs, like Wisconsin’s Badgercare, are their closest contact with the state. This is how people learn firsthand about government. For example, Medicaid recipients are more likely to participate in elections and other forms of politics when they live in states that have expanded coverage or that offer a wider scope of benefits, like dental and vision services. The opposite is true for beneficiaries who live in states that have restricted benefits and services.1COMMENTMany Medicaid beneficiaries already feel stigmatized. A woman we met in Chicago was an uninsured diabetic in her early 60s who desperately needed health care. But she was treated so badly when she applied for Medicaid that she walked away.Drug testing threatens a huge portion of the country. Twenty percent of Americans already depend on Medicaid, and millions more are only one bad break away from the prospect of urinating in a cup to prove that they deserve health care.

Continue reading the main storyhttps://www.nytimes.com/2017/06/28/opinion/drug-test-poor-medicaid-walker-trump.html?emc=edit_th_20170628&nl=todaysheadlines&nlid=35747334

Jamila Michener is an assistant professor of government at Cornell, where Julilly Kohler-Hausmann is an assistant professor of history.

About as many Americans are expected to die this year of drug overdoses as died in the Vietnam, Iraq and Afghanistan wars combined.For more than 100 years, death rates have been dropping for Americans — but now, because of opioids, death rates are rising again. We as a nation are going backward, and drug overdoses are now the leading cause of death for Americans under 50.“There’s no question that there’s an epidemic and that this is a national public health emergency,” Dr. Leana Wen, the health commissioner of Baltimore, told me. “The number of people overdosing is skyrocketing, and we have no indication that we’ve reached the peak.”Yet our efforts to address this scourge are pathetic.We responded to World War II with the storming of Normandy, and to Sputnik with our moon shot. Yet we answer this current national menace with … a Republican plan for health care that would deprive millions of insurance and lead to even more deaths! TO CONTINUE READING:​ https://www.nytimes.com/2017/06/22/opinion/opioid-epidemic-health-care-bill.html?emc=edit_th_20170622&nl=todaysh

Patients with opioid use disorder are much more likely than the general population to have a host of other health conditions, including hepatitis C, post-traumatic stress disorder, and anxiety.That’s according to a new analysis from health care company Amino, which culled data from the claims of 3.1 million privately insured patients between 2014 and 2016. It calculated the frequency of a slew of health conditions — from back pain to binge drinking — in patients diagnosed with opioid use disorder. Then, it compared those rates to the general patient population.Here’s what it found.​TO CONTINUE: https://www.statnews.com/2017/06/19/opioid-abuse-health-conditions/

These days, it feels like there’s no shortage of threats. Fears of national security breaches, terrorism, global warming and more all play in surround sound in the media and on Capitol Hill.With all of these dangers dominating the news cycle and the congressional calendar, it’s easy to forget the silent threats that also deserve our attention. One of these noiseless threats is viral hepatitis.

Viral hepatitis isn’t in on the evening news every day, but it kills more Americans every year than HIV and all other infectious diseases combined — and it’s on the rise.

An estimated five million people are living with hepatitis B or hepatitis C in the United States. The diseases, which cause cirrhosis (scarring) of the liver and liver failure, directly lead to 21,000 deaths in the U.S. each year. Viral hepatitis is also the leading cause of liver cancer —the fastest-growing cause of cancer mortality in the U.S. which kills twice as many Americans now than it did in the 1980s.Not only is viral hepatitis killing more people; it’s also spreading.

AMERICANS OVER 50 are using narcotic pain pills in surprisingly high numbers, and many are becoming addicted. While media attention has focused on younger people buying illegal opioids on the black market, dependence can also start with a legitimate prescription from a doctor: A well-meant treatment for knee surgery or chronic back troubles is often the path to a deadly outcome.Consider these numbers:• Almost one-third of all Medicare patients — nearly 12 million people — were prescribed opioid painkillers by their physicians in 2015.• That same year, 2.7 million Americans over age 50 abused painkillers, meaning they took them for reasons or in amounts beyond what their doctors prescribed.• The hospitalization rate due to opioid abuse has quintupled for those 65 and older in the past two decades.From pain to addictionBehind the numbers are the shattered lives of many who never dreamed they'd become drug abusers.Cindy Thoma, 63, who owns and operates a bookstore in Muskegon, Mich., became addicted to opioid pain pills after being injured in a car crash with a drunk driver who ran a red light. "I was running away from my pain," she says. "I did well at first. But I began to take them sooner, which meant I needed more. I needed more because my body got used to the narcotics."The way opioids are often prescribed, dependence can set in after just a few days, experts say. "Within one week you've made that person physiologically dependent on the drug, meaning they feel some discomfort or side effects when they stop using," says Andrew Kolodny, executive director of Physicians for Responsible Opioid Prescribing."I was very, very sick. My mind was not right for a long, long time."

—Cindy Thoma, 63, sober for five years following an eight-year opioid addictionThoma stopped abusing opioids after years of struggle. But for too many, their stories end badly.Nearly 14,000 people age 45-plus died from an opioid overdose in 2015 — 42 percent of all such deaths in the U.S., according to the Centers for Disease Control and Prevention (CDC).The actual number is likely much higher. Overdoses in older people are often mislabeled as heart failure or falls, Kolodny says."The deaths of older people are an untold part of it," says Jeremiah Gardner, public affairs manager of the Hazelden Betty Ford Institute for Recovery Advocacy. Gardner speaks from personal experience: His mother died two years ago from an overdose after becoming dependent on painkillers prescribed for chronic pain and a surgery. She was 59.So how did we get here?KEVIN J. MIYAZAKICynthia Thoma is the owner of Gracie's Book Store in Muskegon, Mich.

The sin of overprescription"We overestimated the benefits of opioids and underestimated the risks," says Deborah Dowell, senior medical adviser at the CDC. "We assumed without adequate evidence that they would work as well long term as they did in the short term."Pharmaceutical companies have marketed opioids aggressively to physicians, especially after the Federal Drug Administration approved OxyContin in 1995. "The campaign that led to the increase in opioid prescriptions was multifaceted," Kolodny says.For example, Purdue Pharma, the maker of OxyContin, held pain management conferences in states like Florida that were attended by more than 5,000 doctors, nurses and pharmacists.So beginning in the late '90s, when older patients suffering from chronic conditions like arthritis or back issues asked for pain relief, their doctors innocently wrote prescriptions for OxyContin, Vicodin, Percocet and other opioid painkillers.By 2012, addiction rates and the number of overdose deaths had soared. In that year, 259 million opioid prescriptions were written — enough for every adult in the U.S. to have one. "Many doctors still think seniors can't get addicted."

Andrew Kolodny, executive director of Physicians for Responsible Opioid PrescribingThe trade group representing most opioid manufacturers, PhRMA, did not return calls for comment. Purdue Pharma said in a statement, "The opioid crisis is among our nation's top health challenges," and the company is committed to being "part of the solution."The teaching in medical school used to be that opioid medication is not addictive as long as it is given to someone in legitimate pain — something we now know not to be true, says Vivek Murthy, who left the job of U.S. surgeon general in April.It did not help that in 2009 the American Geriatric Society encouraged physicians to use opioids to treat moderate to severe pain in older patients, citing evidence that they were less susceptible to addiction. Though the society revised those guidelines, the myth persists. "Many doctors still think seniors can't get addicted," Kolodny says.Last August, then-Surgeon General Murthy wrote a letter to every doctor in America. "Nearly two decades ago, we were encouraged to be more aggressive about treating pain, often without enough training and support to do so safely," the letter said."This coincided with heavy marketing of opioids to doctors. Many of us were even taught — incorrectly — that opioids are not addictive when used as pain relief. The results have been devastating."The CDC issued guidelines last year recommending that doctors drug-test their patients before and during opioid therapy, to ensure that the medications are taken properly.But doctors still overprescribe. A 2016 survey by the nonprofit National Safety Council found that 99 percent of physicians prescribe opioids beyond the dosage limit of three days recommended by the CDC.Thoma had no trouble getting opioids. "I could get them from different doctors, and there was no communication between them about what they were prescribing," she says. "You could get it fairly easily." In eight years, she lost her job and home and went bankrupt. Finally, she forced herself to stop. "I was very, very sick. My mind was not right for a long, long time."A need for treatment optionsAs people age, they can become more at risk for dependence or overdoses. To start, they are more likely to have serious pain. Kidney and liver function slows with age, increasing the time drugs remain in the system. And memory loss can make it harder to manage opioid medication effectively.Solving the problem will require major changes, experts say. There is an urgent need for more treatment centers able to administer to older patients. That includes counseling tailored to older patients. It doesn't work to have "a buttoned-up elderly person sitting next to a guy in his 20s who is pierced and tattooed," says David Frenz, a Minneapolis physician certified in addiction medicine. And doctors need to be trained on medications used to treat opioid addiction, experts say.There also needs to be a major attitude shift. "Some people still hold the mistaken belief that it's a moral failing instead of a chronic medical condition that requires treatment," says Melinda Campopiano, senior adviser for the federal Substance Abuse and Mental Health Services Administration.But there are happy endings.TO CONTINUE::https://www.google.com/search?q=aarp+bulletin+article+re+the+opioid+menace&rlz=1C1CHBD_enUS707US707&oq=aa

AARP is a nonprofit, nonpartisan organization that helps people 50 and older improve the quality of their lives.

The Unites States of America is facing the worst health care crisis of our nation’s history. Over the past two-year period, more Americans died of opiate addictionthan died in the entire Vietnam War. Drug overdoses now cause more deaths than gun violence and car crashes. In fact, accidental opioid overdoses are responsible for more deaths in 2015 than HIV/AIDS did at the height of the epidemic in 1995.However, the AIDS epidemic can be the blueprint for the United States approachto the opioid epidemic. Once America became mobilized against AIDS, Congress orchestrated intensive efforts devoted to training and supporting clinicians, many of whom were new to the treatment of viral infections in immunocompromised patients.Immediately, a collaboration led to one standardized set of treatment guidelines that were implemented through newly formed AIDS Education and Training Centers. Funding was provided to connect patients with capable providers of wrap-around social services supported by grants from the Ryan White HIV/AIDS Program.Once America becomes mobilized against the heroin epidemic, similarly, social workers, nurse care managers, and outreach workers could be deployed strategically to help obtain substance-abuse treatment in primary care settings, and funding incentives authorized by the Affordable Care Act (ACA), such as health homes and accountable care organizations, could help cover the costs.The current treatment guidelines for opioid addiction just do not work. Today, thousands of patients receive medical treatment to relieve opioid withdrawal only during brief detoxification admissions, lose their tolerance to opioids and get discharged with referrals to medication-free residential or outpatient care. Of these patients, 70 to 90 percent quickly relapse and face a high risk of overdose death.On June 5, 2017, the New York Times reported that drug overdose deaths in 2016 would most likely land someplace between 59,000 and 65,000 Americans. That is a 19 percent rise in deaths from the 52,404 recorded in 2015. Drug overdoses are now the leading cause of death among Americans under 50.But the solution is simple. We need treatment facilities, we need them now, and we need to create a radical model to accomplish the herculean task.Tim Grover, a Lowell, Massachusetts businessman, buried his 26-year old daughter, Megan in 2014. On Christmas Eve, Megan had to leave a treatment center because of red tape. It is not clear exactly what happened that evening, but it had something to do with insurance mandates for the separation and clarification of detox facilities versus treatment centers.No joke, it was something along the lines of my friend’s son who first detoxed himself off heroin in the basement of his mother’s house and then pounded the streets looking for a 30-day treatment facility. The only problem, he was shut-out because he had to be “referred by a licensed detox facility.”He had no choice but to get high, go to a detox and then attempt long term treatment. Desperate, he did just that. But now his mother visits him in the cemetery. The first bag of heroin he bought was Fentanyl, and it ended his life.Back to Tim Grover and his daughter, Megan. The Christmas Eve debacle wasn’t their first rodeo. After a serious automobile accident when Megan was 17, she was prescribed OxyContin to treat pain from her injuries. That, unfortunately, like so many countless others, rang the bell that sounded rehab after rehab and relapse after relapse.But on the night of Dec. 29, 2014, Tim received a phone call from Megan. She was extremely happy. There was a bed available in a Boston treatment facility the next morning. Tim told Megan he loved her and went to bed at rest.Tomorrow never came. Tim Grover buried Megan on Jan. 5, 2015, and 24 hours later, Tim purchased a vacant Riverside School in Lowell, Massachusetts and opened the residential treatment home for women, Megan’s House, on Sep. 30, 2015. Tim Grover was angry at God, angry at the system that failed his daughter, and felt socially responsible for helping other young women like Megan.It is time to be socially responsible and mobilize America against this health crisis. We can never Make America Great Again if we just stand by and watch the impact heroin is having on poverty, joblessness, crime, and the deteriorating communities of the Heartland of our great nation.